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General NPI Number Information
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NPI Number | 1801417563
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Entity Type | Individual
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Provider Name | SANGWOOK LEE DC
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Gender | Male
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Dates
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Enumeration Date | 05/04/2020
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 680 S BERENDO ST APT 529
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City | LOS ANGELES
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State | CA
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Zip | 90005-2087
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Country | US
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Telephone | 916-260-6198
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Fax |
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Provider Business Mailing Address
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Address Line | 17411 IRVINE BLVD STE H
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City | TUSTIN
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State | CA
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Zip | 92780-3025
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Country | US
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Telephone | 916-260-6198
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 34381
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License Number State | CA
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